Spontaneous heterotopic triplet pregnancy with intrauterine monochorionic-monoamnionic twins

Abstract Heterotopic pregnancies are an unusual phenomenon, which have recently become more prevalent with assisted reproductive technologies (ART). Triplets that are part of a heterotopic pregnancy are exceedingly rare. Here, we describe a case of a woman who presented at 15+1 weeks of gestational age with a known monochorionic-monoamniotic intrauterine pregnancy with several days of abdominal pain with an otherwise unremarkable gastrointestinal (GI) assessment. Salpingectomy was performed, and pathology revealed chorionic villi within the fallopian tube consistent with a heterotopic triplet pregnancy. This pregnancy was conceived spontaneously. Even without the prior use of ART, physicians need to be aware of the risk of heterotopic pregnancy in a patient with a known twin gestation. In addition, this case highlights how heterotopic triplets can present even within the second trimester.

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Heterotopic pregnancy: case report of a successful first trimester metacyesis management and a viable third trimester outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20185448 ◽

2018 ◽

Vol 8 (1) ◽

pp. 332

Author(s):

Arvind Kumar Singh ◽

Shazia Khan

Keyword(s):

Case Report ◽

Maternal Morbidity ◽

Assisted Reproductive Technologies ◽

First Trimester ◽

Reproductive Technologies ◽

Heterotopic Pregnancy ◽

Third Trimester ◽

Intrauterine Pregnancy ◽

The Past ◽

Maternal Morbidity And Mortality

Heterotopic pregnancies are rare combined intra and extrauterine pregnancies, the incidence of which has shown an increase over the past decade with the rising trend in assisted reproductive technologies (0.75-1.5%). Authors report a case of a 29 year old primigravida, a post IVF conception who presented at 6 weeks POG with a ruptured tubal and a viable intrauterine pregnancy. She underwent an emergency laparoscopic right salpingectomy and continued with her intrauterine pregnancy successfully till term. The article emphasizes the need of scanning the adnexa carefully in early pregnancy to diagnose and manage heterotopic pregnancy as early as possible to prevent catastrophic haemorrhage and maternal morbidity and mortality later.

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Heterotopic Triplet Pregnancy after In Vitro Fertilization with Favorable Outcome of the Intrauterine Twin Pregnancy Subsequent to Surgical Treatment of the Tubal Pregnancy

Case Reports in Obstetrics and Gynecology ◽

10.1155/2014/356131 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 5

Author(s):

Theodoros Felekis ◽

Christodoulos Akrivis ◽

Panagiotis Tsirkas ◽

Ioannis Korkontzelos

Keyword(s):

In Vitro Fertilization ◽

Assisted Reproductive Technologies ◽

Medical Condition ◽

Reproductive Technologies ◽

Tubal Pregnancy ◽

Successful Outcome ◽

Triplet Pregnancy ◽

Intrauterine Pregnancy ◽

Vitro Fertilization

Heterotopic triplet pregnancy is an exceptionally rare medical condition. The broad use of assisted reproductive technologies has contributed to the increase of ectopic and subsequently heterotopic pregnancy rate, masking a life-threatening condition for the gravid and the intrauterine pregnancy. We describe a case of a woman with heterotopic triplets at 9+4gestational week following transfer of three embryos obtained by in vitro fertilization techniques. The ectopic tubal pregnancy was ruptured and salpingectomy was performed by laparotomy. The intrauterine pregnancy progressed to the delivery by cesarean section of two healthy twins at 36+2gestational age. Heterotopic triplets with tubal ectopic are a special diagnostic and therapeutic challenge for the obstetrician. High index of suspicion and timely treatment by laparotomy or laparoscopy can preserve the intrauterine gestation with a successful outcome of the pregnancy.

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Ruptured Tubal Ectopic Pregnancy at Fifteen Weeks Gestational Age

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2019.1.40860 ◽

2019 ◽

Vol 3 (1) ◽

pp. 62-64 ◽

Cited By ~ 3

Author(s):

Justine Stremick ◽

Kyle Couperus ◽

Simeon Ashworth

Keyword(s):

Abdominal Pain ◽

Ectopic Pregnancy ◽

Gestational Age ◽

Vaginal Bleeding ◽

First Trimester ◽

Second Trimester ◽

Intrauterine Pregnancy ◽

Tubal Ectopic Pregnancy ◽

Ectopic Pregnancies ◽

First Trimester Ultrasound

Tubal ectopic pregnancies are commonly diagnosed during the first trimester. Here we present a second-trimester tubal ectopic pregnancy that was previously misdiagnosed as an intrauterine pregnancy on a first-trimester ultrasound. A 39-year-old gravida 1 para 0 woman at 15 weeks gestation presented with 10 days of progressive, severe abdominal pain, along with vaginal bleeding and intermittent vomiting for two months. She was ultimately found to have a ruptured left tubal ectopic pregnancy. Second-trimester ectopic pregnancies carry a significant maternal mortality risk. Even with the use of ultrasound, they are difficult to diagnose and present unique diagnostic challenges.

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Heterotopic Pregnancy in a Natural Conception

International Journal of Infertility & Fetal Medicine ◽

10.5005/jp-journals-10016-1007 ◽

2010 ◽

Vol 1 (1) ◽

pp. 41-43 ◽

Cited By ~ 1

Author(s):

Sumeet N Baheti ◽

K Jayakrishnan

Keyword(s):

Abdominal Pain ◽

Hemorrhagic Shock ◽

Transvaginal Ultrasound ◽

Heterotopic Pregnancy ◽

Intrauterine Pregnancy ◽

Abnormal Pregnancy ◽

Emergency Laparoscopy ◽

Life Threatening ◽

Natural Conception ◽

High Index Of Suspicion

ABSTRACT Heterotopic pregnancy is rare in natural conception and most often presents as life threatening emergency like acute abdomen and hemorrhagic shock. In early unruptured stages, it presents nonspecifically, mimicking normal or abnormal pregnancy manifestations. A high index of suspicion and a definitive search for it even after confirming normal intrauterine gestation is needed. This little effort ensures a timely diagnosis and management thus preventing catastrophe. We hereby report a primigravida with unruptured heterotopic pregnancy following a natural conception, who presented as nonspecific abdominal pain. Transvaginal ultrasound was inconclusive. Emergency laparoscopy clinched the diagnosis and allowed conservative salpingostomy and continuation of intrauterine pregnancy.

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HETEROTOPIC PREGNANCY

The Professional Medical Journal ◽

10.29309/tpmj/2006.13.01.5079 ◽

2006 ◽

Vol 13 (01) ◽

pp. 162-164

Author(s):

FARKHUNDA AKTHAR

Keyword(s):

Abdominal Pain ◽

Rare Case ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Tubal Pregnancy ◽

Heterotopic Pregnancy ◽

Atypical Presentation ◽

Intrauterine Pregnancy ◽

Ectopic Gestation

A rare case of simultaneous tubal pregnancy and intrauterine pregnancy is discussed. Patient hadan atypical presentation of abdominal pain and a abnormal uterine bleeding but no period of amenorrhea. On clinicalexamination there was suspicion of ectopic gestation but ultrasonography revealed early intrauterine pregnancy alongwith luteal cyst. Because of increase severity of pain she was reviewed again. Repeat sonography findings wereconsistent with heterotopic which was confirmed by laparotomy and histopathology.

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Lesioni cutanee stellate e simmetriche in un gemello “rimasto solo”

Medico e Bambino ◽

10.53126/meb403783 ◽

2021 ◽

Vol 40 (6) ◽

pp. 383-385

Author(s):

Claudia Sciarrotta ◽

Gregorio Serra ◽

Mandy Schierz ◽

Giovanni Corsello

Keyword(s):

Twin Pregnancy ◽

Assisted Reproductive Technologies ◽

Multiple Pregnancy ◽

Reproductive Technologies ◽

Intrauterine Death ◽

Second Trimester ◽

Aplasia Cutis Congenita ◽

Multiple Gestations ◽

Vanishing Twin Syndrome ◽

Twin Pregnancies

The incidence of multiple pregnancy has increased, particularly because of the advances in assisted reproductive technologies. Multiple gestations are high risk pregnancies, especially the monochorionic ones. Two/thirds of initially twin pregnancies result in singles at birth, a condition defined as vanishing twin syndrome. The intrauterine death of one of the twins can cause direct fetal damage to the surviving one on several levels. The paper describes the case of a child born from twin pregnancy that was interrupted for one of the co-twins at early second trimester of gestation who presented with aplasia cutis congenita.

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Heterotopic Pregnancy: A Clinical Case Report

Bangladesh Medical Journal ◽

10.3329/bmj.v39i3.9950 ◽

1970 ◽

Vol 39 (3) ◽

Author(s):

S Chowdhury ◽

T Chowdhury

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Ectopic Pregnancy ◽

Clinical Examination ◽

Clinical Case ◽

Lower Abdominal Pain ◽

Tubal Pregnancy ◽

Heterotopic Pregnancy ◽

Intrauterine Pregnancy ◽

Ectopic Pregnancies

Heterotopic pregnancy is coexistence of intrauterine and extrauterine pregnancies that is ectopic pregnancies. It is said to be rare. Here we report a case of 27 years old woman with heterotopic pregnancy. Patient had a typical presentation of severe lower abdominal pain following amenorrhoea for 2½ months. On clinical examination, there was suspicion of ectopic pregnancy but ultrasonography revealed early intrauterine pregnancy along with right tubal pregnancy with huge collection in abdomen . Immediate laparotomy was done and diagnosis was confirmed as a case of heterotopic pregnancy.DOI: http://dx.doi.org/10.3329/bmj.v39i3.9950 BMJ 2010; 39(3)

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